MCCL March Break Camp Registration
Student Name*

First Name

Last Name

Address 1

Address 2




Postal Code
Student Email*
Student Phone Number*
Preferred method of contact for Student*
School attended
Parent/Guardian Full Name*
First Name Last name
Parent/Guardian Phone #*
Parent/Guardian Email*
Preferred method of contact for Parent/Guardian*
Emergency Contact Name*
First Name Last Name
Emergency Contact Phone #*
Do you have any medical conditions or allergies we should know about?*
We will do our best to accommodate your needs for snacks.
What form of transportation will you use to get to/from the camp?
How did you learn about our camp?*
I give MCCL permission to use photos, videos, quotes belonging to me (Student registering)*

I would like to learn more about MCCL upcoming events and programming.*